Question: I am confused as some of your old notes and other clinicians recommend adding heparin to IV’s to avoid thrombosis. Is this correct?
Answer:
Good point. In my notes (and those of Dr. Osborne and I in the EDTA class) those are “historical purposes only” formulas as we say when presenting them. Reason is we know more than we did 10 or 30 years ago about these issues. Reason Heparin is almost never ever needed (I go over this in all the classes / writing I do on cancer, chelation etc., but it goes quickly and is in the midst of so much else it’s easy to forget) is that the causes of phlebitis and phlebothrombosis from current literature (in order of importance) are:
1: pH
2: Dehydration
3: Osmolarity
4: Admin rate
5: occasionally temperature
So to avoid clotting:
– Every IV bag is checked for pH and adjusted to 6.5-7.5 the major reason is taken care of.
– in the chronically ill and cancer patients we generally pre-hydrate them IV with 500 mL 0.45 NS or 0.9. They just can’t drink enough.
– an option although less desirable in most cases is putting the formula in more SWI – but in our experience pre-hydration is better.
– watch admin times closely.
And in most cases this takes care of these issues without heparin. Heaprin as a flush is used in PICC/PORT and Hep-loc situations as normal.
